Hindsight: Endothelial Cell Specific Molecule-1 and Obesity
In 2006, we published a paper in Homone and Metabolic Research, in which we reported on endothelial-cell specific molecule-1 (ESM-1), a molecule which inhibits leukocyte adhesion and migration through the endothelium and also happens to be secreted by fat cells. In this study we looked at ESM-1 expression and regulation in subcutaneous abdominal adipose tissue samples from 70 postmenopausal women. In cell culture studies we found that mature adipocytes produced more ESM-1 than preadipocytes. We also found that insulin and cortisol inhibited adipocyte ESM-1 production. This inhibitory effect of insulin was attenuated by insulin resistance, as ESM-1 gene expression in subcutaneous adipose tissue was increased in obese, hyperinsulinemic women. On the other hand, modest 5% weight loss in 14 women did not markedly change gene expression. Circulating ESM-1 levels increased significantly, albeit modestly. Thus, we confirmed that ESM-1 is actively produced by adipocytes but that circulating ESM-1 levels are reduced in the overweight and obese, consistent with the notion that ESM-1 may play some role in obesity-associated vascular disease. This clearly did not turn out to be a hotbed of adipocyte research – according to Google Scholar, this paper has only been cited 13 times. AMS Orlando, FL
5As of Obesity Management at ASBP
This morning I am presenting an hour-long plenary talk on the Canadian Obesity Network’s 5As of Obesity Management at the 62nd Annual Symposium of the American Society of Bariatric Physicians (ASBP) in Orlando. Founded in 1950, ASBP describes itself as, “…a medical professional association for physicians, nurse practitioners and physician assistants focused on the treatment and management of overweight and obese patients and their related conditions.” Attendance at this conference and participation in the review courses count towards obtaining and maintaing American Board Certification in Obesity Medicine, a joint venture of several US obesity organisations including American College of Sports Medicine (ACSM) American Congress of Obstetricians and Gynecologists (ACOG) American Gastroenterological Association (AGA) American Heart Association (AHA) American Society for Metabolic and Bariatric Surgery (ASMBS) American Society for Nutrition (ASN) American Society for Parenteral and Enteral Nutrition (ASPEN) American Society of Bariatric Physicians (ASBP) STOP Obesity Alliance The Endocrine Society (ENDO) The Obesity Society (TOS) According to the description on the ABOM website, “An obesity medicine physician is a physician with expertise in the sub-specialty of obesity medicine. This sub-specialty requires competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity. The obesity medicine physician employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy. The obesity medicine physician utilizes a comprehensive approach, and may include additional resources such as nutritionists, exercise physiologists, psychologists and bariatric surgeons as indicated to achieve optimal results. Additionally, the obesity medicine physician maintains competency in providing pre- peri- and post-surgical care of bariatric surgery patients, promotes the prevention of obesity, and advocates for those who suffer from obesity.” Currently no such specialization exists in Canada, which is why several Canadian docs have taken or are preparing for the US certification exams. While specialist certification in obesity is certainly laudable, it is also important that the general practitioner, or in fact all health professionals, have at least minimal competencies in approaching and helping patients address their weight related health problems. This is the purpose of the Canadian Obesity Network’s 5As of Obesity Management program, which was specifically designed for the busy non-specialist working in primary care, upon whom the task of managing the vast majority of obesity individuals ultimately falls. Thus, while little that I have to say about obesity management may be new to obesity specialists, all of what is contained… Read More »
Therapeutic Recreation in Obesity
This morning I am presenting a talk and workshop on obesity at the 2012 Annual Symposium of the Alberta Therapeutic Recreation Association, “Navigating Challenges & Changes in TR”, being held here in Edmonton, October 24-25-26, 2012. Faithful readers, may recall a previous post, in which I wondered if there would be a role for recreational therapists in obesity management. As I noted in that post, “….recreational therapists are the professional experts in helping clients to rediscover and maximise independence in leisure, optimal health and quality of life. Recreational therapy has been shown to reduce depression, stress, anxiety, as well as recover or maintain motor functioning, reasoning abilities and build confidence that allows clients to enjoy greater independence and quality of life. Established benefits of therapeutic recreation include maintenance of physical and pscyhosocial health, cognitive functioning, personal and life satisfaction, and prevention of complications of physical disabilities and improved self-care and adherence to treatment plans.” As I also noted, “These services would most certainly be relevant to many of the severely obese patients that we see in our clinic, who have experienced social isolation due to their excess weight and have certainly lost much of their social network and interactions.” I very much look forward to participating in this conference and to learning more about the potential role of therapeutic recreation in the care and rehabilitation of bariatric patients. AMS Edmonton, Alberta
Ontario Docs Call For an Anti-Tobacco Approach to Childhood Obesity
Yesterday (October 23, 2012), Ontario’s doctors proposed aggressive new measures to tackle childhood obesity that are modelled largely on anti-tobacco campaigns and propose that similar measures be imposed on ‘obesity-causing foods’. In the case of tobacco, measures included tax increases, public information (including disturbing images of diseased lungs and other graphic depictions of the negative effects of smoking), removal of retail tobacco displays, and advertising bans. In analogy to such measures, the specific recommendations to reverse the course of childhood obesity include: – Increasing taxes on junk food and decreasing tax on healthy foods; – Restricting marketing of fatty and sugary foods to children; – Placement of graphic warning labels on pop and other high calorie foods with little to no nutritional value; – Retail displays of high-sugar, high-fat foods to have information prominently placed advising consumer of the health risks; and – Restricting the availability of sugary, low-nutritional value foods in sports and other recreational facilities that are frequented by young people. These recommendations add to previous recommendations calling for – Legislation that would require calorie contents to be listed adjacent to the items on menus and menu boards at chain restaurants and school cafeterias; – An education campaign to help inform Ontarians about the impact of caloric intake on weight and obesity; and – Making physical activity/education mandatory throughout high school. In a quote that accompanies this announcement, Doug Weir, President of the Ontario Medical Association notes that, “The time for gentle admonitions has come and gone. We need to fight this problem with proven tools like tax incentives and graphic warnings. There is an enormous body of evidence that these measures work.” Regular readers of these pages, would not be surprised to learn that I am not entirely happy with these proposals and would have several ‘bones to pick’ with such an approach to tackling obesity in kids (or anyone else). Rather than calling for populistic and unproven policy strategies, many of which fall in the categories of tax, ban, shame, blame, scare, punish, and have yet to prove effective in any jurisdiction in preventing childhood (and ultimately adult) obesity, I would have much preferred Ontario’s doctors to turn inward to look at steps that they could themselves take to better tackle this epidemic in their offices (such as perhaps implement the 5As of Obesity Management in their practices?). It is no secret, for example, that most… Read More »
UK Report Finds Inadequate Pre- and Post-Surgical Care for Bariatric Patients
Last month, the UK National Enquiry into Patient Outcome and Death (NCEPOD) released a report (Bariatric Surgery: Too Lean a Service) on the process of care for patients aged over 16, who underwent bariatric surgery for weight loss in the UK and found that significant improvements are needed across the whole of the care pathway, with more emphasis on specialist support before and after surgery. The report is based on findings from in-depth case reviews of 381 patients who had bariatric surgery with the UK National Health System (n=223) or in private hospitals (n=173) in England, Wales, Northern Ireland, the Isle of Man, Guernsey, and Jersey. The report highlights a number of important deficiencies in the care of these patients including, lack of assessments and consultations by dietitians or psychologists both before and after surgery, significant delays in follow-up, surgery on patients who did not meet guidance criteria, high readmission rates, inadequate consent forms and procedures, low surgical volumes, and lack of follow-up. It also found that two out of three websites of programs failed to give a clear explanation of the risks involved and of the chances of achieving weight loss. The report lists a number of proposals to improve bariatric surgery including ensuring that all patients have access to the full range of appropriate specialist professionals, a deferred two-stage consent process, and postoperative dietary guidance. It also clearly recommends that all decisions on whether or not a patient is suitable/ready for weight loss surgery should be made with the input of a number of different health care professionals. Although standards may well vary between countries, I have no doubt that careful review of the quality of pre-, peri-, and post-surgical care of bariatric surgery patients will probably leave much to be desired in most countries, including perhaps in Canada. The report certainly makes clear that neither the decision to undergo surgery nor the processes and standards to ensure acceptable outcomes are to be taken lightly. Bariatric surgery (even in its most minimally invasive form) remains a serious and complex intervention for a serious and complex problem – any health professional suggesting anything else, is guilty of nothing less than professional misconduct. AMS Edmonton, Alberta
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